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General NPI Number Information
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NPI Number | 1568863330
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Entity Type | Organization
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Legal Business Name | MG CHIROPRACTIC LLC
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Dates
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Enumeration Date | 09/11/2014
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Last Update Date | 01/21/2020
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Provider Practice Location Address
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Address Line | 928 NW LEARY WAY SUITE 203
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City | SEATTLE
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State | WA
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Zip | 98107
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Country | US
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Telephone | 425-387-7215
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Fax |
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Provider Business Mailing Address
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Address Line | 928 NW LEARY WAY SUITE 203
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City | SEATTLE
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State | WA
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Zip | 98107
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Country | US
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Telephone | 425-387-7215
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MASON M GREENSLADE
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Credential | D.C.
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Telephone | 425-387-7215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 60431420
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License Number State | WA
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